The Impact of Oxytocin on the Neurobiology of Anorexia Nervosa

The primary objective of this investigation is to determine the impact of oxytocin (OT), a
peptide hormone that influences social affiliation, on socioemotional neural circuitry and
eating disorder behavior in anorexia nervosa (AN). Because socioemotional processing deficits
appear to play a key role in AN, OT is implicated as a potential biological mechanism by
which eating disorder behavior (e.g., restrictive eating) is maintained. Used as a probe,
intranasal oxytocin (INOT) provides an innovative method for examining the short-term impact
of OT on socioemotional neural processing disturbances and eating disorder behavior in AN.
The proposed study tests a theoretical model of the role of OT in the maintenance of AN by
using an INOT probe to determine, and potentially alter, neurobiological responses to
socioemotional stimuli. Specifically, this study will use a randomized, controlled,
double-blind design involving the administration of INOT or placebo to adults with AN
restricting subtype and age-matched controls prior to neuroimaging to assess the impact on
frontolimbic brain activity in response to socioemotional stimuli. The potential impact of
INOT on restrictive eating will also be assessed in a subsequent test meal. We predict that
for participants with AN, INOT, but not placebo, will normalize frontolimbic activation in
response to social reward stimuli and prefrontal activation in response to social threat
stimuli. In addition, the investigators predict that AN participants will display reduced
restrictive eating in a test meal paradigm following INOT (but not placebo) administration.
Finally, investigators predict that changes in restrictive eating following INOT
administration will be mediated by altered frontolimbic responding to socioemotional cues.
This investigation will provide an essential link uniting the data supporting the importance
of socioemotional processing deficits in AN with the emerging role of INOT in altering the
neural circuits involved in social behavior to test an innovative neurobiological maintenance
model of AN.

Inclusion Criteria:

- All participants:

1. Age > 18 years old

2. Female (given the potential sex differences to endogenous OT to INOT)

3. Ability to read and speak in English

4. Right-handed

- Anorexia nervosa participants:

1. DSM-5 diagnosis of AN, restricting subtype (established by the SCID-5-RV),

2. BMI < 18.5 kg/m2 within the past month

Exclusion Criteria:

All participants

1. Medical instability or current pregnancy or lactation

2. Current substance use disorder, psychosis, or bipolar-I disorder

3. Contraindication for fMRI (e.g., implanted metal)

4. History of neurological disorder/injury (e.g., stroke; head injury with > 10
minutes loss of consciousness)

5. Food allergy that cannot be accommodated through substitutions to the laboratory
test meal

6. Lacking capacity to consent

7. Contraindications for intranasal oxytocin administration

8. Acute suicidality

9. Psychoactive medication (e.g., antidepressants, antipsychotics)

Exclusion for participants without anorexia nervosa

1. Current DSM-5 Axis-I diagnosis or current or past eating disorder diagnosis

2. BMI < 19.0